Timely nudges promote patient portal enrollment and sustained engagement: a randomized controlled trial

Patient portals support health management, yet enrollment remains low. This study evaluated whether timely email nudges increase patient portal enrollment compared with usual system portal invitations, whether message framing influences enrollment, and whether patients nudged to enroll go on to engage with the portal at similar rates as those who enroll organically.

In this pre-registered randomized controlled trial at a large health system, 5009 patients aged ≥ 18 with recently released laboratory results were randomized over 15 days to: (1) an "Ease" email suggesting immediate access to laboratory results, upon enrollment, (2) a "Transparent" email outlining registration steps needed to access their results, or (3) no email. The primary outcome was portal enrollment within one week. Secondary outcomes included enrollment rates over four years and post-enrollment portal engagement. Post hoc analysis examined the impact of time-sensitive test results.

Compared with control, receiving either nudge increased one-week portal enrollment (10.8% vs 3.9%; OR 2.99, P < .001). This difference remained significant through one year post-nudge (36.5% vs 33.1%; OR 1.23, P = .005). Message framing had no significant effect on enrollment. Among emailed patients, nudges were more effective with time-sensitive laboratory results (OR 1.46; P < .001). Among enrollees, long-term portal usage was similar across groups.

Beyond standard marketing efforts, timely nudges highlighting the immediate benefit of accessing laboratory test results can meaningfully increase patient portal enrollment-especially when results are time-sensitive. These low-cost, one-time interventions can drive adoption without sacrificing long-term engagement.